Search

This study examined several trauma scoring systems that serve as the basis for applying the Secondary Assessment of Victim Endpoint (SAVE) severity classification to propose a method that can be applied during triage. By using an exploratory method, data collected from different trauma scoring systems was qualitatively evaluated. First, it was confirmed that the survival risk ratio (SRR) of the International Classification of Disease-based Injury Severity Score (ICISS) can be used for SAVE severity classification. Second, the Korean Trauma Data Bank (KTDB) of the Central Emergency Medical Center does not indicate the SRR of each injury according to the Korean standard classification of disease and cause of death (KCD). Third, the SRR of injuries, from data acquired from the United States can be used for classification of SAVE severity classification. Fourth, the addition of SRR from the KCD to the KTDB can be used for SAVE severity classification.

Little is known about the effects of parenchymal or vascular amyloid β peptide (Aβ) deposition in the brain. We hypothesized that Aβ strain-specific information defines whether Aβ deposits on the brain parenchyma or blood vessels. We investigated 12 autopsied patients with different severities of Aβ plaques and cerebral amyloid angiopathy (CAA), and performed a seeding study using an Alzheimer’s disease (AD) mouse model in which brain homogenates derived from the autopsied patients were injected intracerebrally. Based on the predominant pathological features, we classified the autopsied patients into four groups: AD, CAA, AD + CAA, and less Aβ. One year after the injection, the pathological and biochemical features of Aβ in the autopsied human brains were not preserved in the human brain extract-injected mice. The CAA counts in the mice injected with all four types of human brain extracts were significantly higher than those in mice injected with PBS. Interestingly, parenchymal and vascular Aβ depositions were observed in the mice that were injected with the human brain homogenate from the less Aβ group. The Aβ and CAA seeding activities, which had significant positive correlations with the Aβ oligomer ratio in the human brain extracts, were significantly higher in the human brain homogenate from the less Aβ group than in the other three groups. These results indicate that exogenous Aβ seeds from different Aβ pathologies induced Aβ deposition in the blood vessels rather than the brain parenchyma without being influenced by Aβ strain-specific information, which might be why CAA is a predominant feature of Aβ pathology in iatrogenic transmission cases. Furthermore, our results suggest that iatrogenic transmission of Aβ pathology might occur due to contamination of brain tissues from patients with little Aβ pathology, and the development of inactivation methods for Aβ seeding activity to prevent iatrogenic transmission is urgently required.

Introduction: Early diagnosis of sepsis is paramount to effective management. The present study aimed to compare the prognostic accuracy of presepsin levels and other biomarkers in the assessment of septic shock and mortality risk in cancer patients. Materials and methods: A total of 74 cancer patients were evaluated for presepsin, lactic acid, C-reactive protein (CRP) levels, and white blood cell count (WBC). Specificity and sensitivity values for septic shock and death were compared between four biomarkers in all patients and those with and without acute kidney injury (AKI). Results: A total of 27 and 29 patients experienced septic shock and died, respectively. The area under the curve (AUC) and sensitivity and specificity estimated for presepsin levels for septic shock were 60%, 74%, and 51%, respectively. The corresponding values for mortality were 62%, 72%, and 49%, respectively. In patients without AKI, AUC of presepsin levels for septic shock and death were 62% and 65%, respectively, in those with AKI, these values were 44% and 58%, respectively. Presepsin levels showed higher sensitivity and specificity values than WBC and higher specificity than CRP but were similar to those of lactic acid levels. Conclusions: Presepsin levels are similar to lactic acid levels in the assessment of septic shock and mortality risk in cancer patients. In patients with AKI, presepsin levels should be considered carefully.

Background: Chronic smokers show differences in pain sensitivity compared to healthy non-smokers. Yet, no study to date has examined whether smoker status has an effect on postoperative pain. Objective: We aim to examine a possible correlation between preoperative smoking and postoperative opioid dose based on the hypothesis that smokers would use higher doses of opioids to manage increased postoperative pain. Study Design: A retrospective observational cohort study. Setting: The National Cancer Center in Korea. Methods: We examined medical record data for patients who had undergone curative resection for either lung or esophageal cancer (lobectomy or bilobectomy for lung cancer or an Ivor Lewis operation for esophageal cancer) between January 1, 2006 and December 31, 2010. We examined the correlation between the total preoperative average number of packs per day multiplied by years of cigarette smoking (pack-years) and morphine equivalent daily doses administered to patients after surgery, considering each type of cancer both individually and together. Partial correlation and regression analyses were performed to determine the causality of a possible relationship between pack-years of cigarette smoking and postoperative opioid dose. Results: A total of 1,129 patients (871 patients with lung cancer and 258 patients with esophageal cancer) were included in the final analysis. There was no significant correlation between total pack-years of cigarette smoking and postoperative opioid dose for lung cancer, esophageal cancer, or both cancer types combined (r = 0.042, -0.012, and 0.037, respectively). In the analysis of both cancer types combined, video-assisted thoracic surgery (VATS) was associated with an 11.1% decrease in opioid dose (β = -0.111, P = 0.003) and epidural analgesia was associated with a 7.2% increase in opioid dose (β = 0.072, P = 0.042). Limitations: The retrospective design of this study is a limitation. Conclusion: Our study did not observe a correlation between preoperative smoking and postoperative opioid dose in patients with lung or esophageal cancer. Key words: Smoking, postoperative pain, opioid, lung cancer, esophageal cancer, analgesia

Opioids are commonly used for postoperative pain control in cancer patients. In addition to pain control, an association between opioid use and long-term oncologic outcomes, such as recurrence or overall survival, has been postulated. The aim of this study was to determine whether postoperative opioid use in patients with non-small cell lung cancer is associated with long-term oncologic outcomes, including recurrence and death. Data obtained from 1009 medical records of patients who underwent curative resection at the National Cancer Center, Korea between January 2006 and December 2010 were retrospectively analyzed. Seven-day opioid use was divided into four quartiles to analyze probability of recurrence and death. Multivariate regression analyses of recurrence and death was conducted, including the calculation of odds ratios. A total of 871 patients were analyzed. When opioid dosage was examined by quartiles, the probability of death and recurrence increased gradually with increasing opioid use. However, in the multivariate regression analysis, the amount of opioid usage did not affect the risk of recurrence or death of lung cancer (P = 0.520 for recurrence; P = 0.659 for death). Opioid use was correlated with outcome when stratified by lung cancer stage (P = 0.004 for recurrence; P = 0.049 for death); however, the odds ratios only slightly increased (1.001 for stage IA-IIIA) for both outcomes. In non-small cell lung cancer patients, the amount of opioid usage does not affect the risk of recurrence and death of lung cancer. There was an association with stage (IA-IIIA), but the effect was negligible. A well-designed prospective study is needed.

Behavioral and nutritional strategies that can help control appetite and energy intake should be developed and tested for their efficacy in body-weight management [1]. Eating slowly is often advised for weight management because slower eating has been hypothesized to allow satiation to register before too much food is consumed. Peripheral biomarkers associated with meal termination include physicochemical measures related to stomach distension and responses of several hormones, including cholecystokinin and glucagon-like peptide 1. It has been proposed that slower rates of ingestion allow more time for these processes to take place, lengthen satiety’s time course, and reduce total energy intake. Speed of eating has long been of interest as a factor potentially contributing to the development of obesity.

The purpose of this study is to investigate the CPR within ambulance. The Subjects were 890 emergency medical technicians in fire department in Gyeonggido. After continuing education program, the emergency medical technicians completed the questionnaires from January to February, 2012. Questionnaire consisted of demographic characteristics, method of chest compression (one handed or two handed), chest compression - ventilation ratio, and hands only CPR. Data were analyzed by frequency analysis and Chi-square test, t-test. One-way analysis of variance (ANOVA) was followed by Scheffe post-hoc test to analyze changes in all parameters between all groups. One handed chest compression accounted for 14.0% and two handed chest compression accounted for 86.0%. Hands only CPR accounted for 71.7% and standard CPR (30:2) accounted for 28.3%. In order to perform the high quality CPR, as least three persons must be dispatched in the ambulance. The flexible management of manpower may improve the survival from the cardiac arrest. A systemic approach for educating and training EMT`s in CPR is needed.

This is the study of actual condition and improvement on emergency medical treatment by 119 emergency medical service personnel. The subjects in this study were 299 emergency medical service personnel. Data were collected from May 1 to August 31 of 2010, and analyzed by SPSS 12.0 program. The major area of study of them were study of emergency medical services 41.5%, study of nursing 10.0%, fire fighting related studies 15.4%, health related studies 1.0%, and others 32.1%. The certificate of them were 1st class emergency medical technician(EMT) 38.1%, 2nd class EMT 33.8%, nurse 9.4%, first aid education 14.0%, and others 4.7%. Frequency of Prehospital emergency care, oxygen supply(274), splint apply(229), spinal immobilization(229), external bleeding control(223), medication(7), intravenous(4). Professionally trained EMT makes possible to secure high quality emergency medical treatment in the prehospital phase. Therefore, it is essential for the quality improvement of prehospital emergency care that well trained EMT ride on the ambulance together and take the responsibility for the treatment and transferring of emergency patients. In order to improve the proficiency of 119 emergency medical services personnel, it is also necessary to provide continuous job training programs for the prehospital emergency medical treatment.

In the event of the emergency patient care, cabin crew must take the charge of the first responder quickly. The basic emergency treatment knowledge of the cabin crew consisted of 80.5%~97.8% when the emergency scene showed up in the passenger and the types of emergency care with that the cabin crew could cope were bleeding control, fever, seizures, myocardial infarction, airway management, and partial airway obstruction management. Considering these cares, the improper emergency types revealed approximately 3.2%~20.0%. In airway obstruction there was followed by loss of consciousness and this led to cardiac arrest. In case of cardiac arrest, the cabin crew must know how to check breathing and to use the automated external defibrillator(AED). The life-threatening cardiac arrest can happen to any passenger in any time, so the cabin crew should meet with the emergency accident and apply the AED to the cardiac arrest victim.

The purpose of this study was to investigate on violence, burn-out, self-esteem of 119 rescue workers to prevent violence damage. This research design is correlation study. Data of 416 rescue workers were collected from March 10 to March 31, 2010. Data were analyzed using the SPSS Win 15.0 program. There was no a statistical significant between general characteristics of 119 rescue workers and violence. But there were statistical significant in age, marital status, certification, monthly income, work experience, position between general characteristics and burn-out, and self-esteem respectively(p

According to a research analysis of the factors which affect the medical utilization fee after an increase of health insurance benefits for patients with serious illnesses based on 225 patients over 6 months, both before and after the increase of benefits, from January, 1st, 2005 to June 30th, and also from January, 1st, 2006 to June 30th. In terms of genders, 67.8% of males were affected, whereas only 32.2% of females were effected, a much higher rate of men than women. Men also had higher rates before and after the increase of benefits. Out of 5 categories related to medication and treatment, radiation testing was the most expensive at about 5,300,000, operation fees were 590,000, and costs of other testing approximately 200,000 with the least expensive category being 120,000 for medication. By looking at the relationship between the fees and increase of benefits, medication was a hospital charge (p

The purpose of the study was to investigate the first response, rescue, and transport of emergency patients in Korea coast guard center workers. A self-administered questionnaire was carried out by 333 maritime police workers working at Korea coast guard center from March-June, 2016. The questionnaire consisted of 25 question items. Data were analyzed using SPSS WIN 21.0. Majority of the study subjects worked at the Korea Coast Guard Center and of them, 96.7% were composed of staff who did not possess emergency medical technician certificate, followed by 2.7% possessing level 2 emergency medical technician certificate, and 0.6% possessing level 1 emergency medical technician certificate. And in terms of the possession of lifeguard certificate, 60.1% of the staff possessed lifeguard certificate which was higher percentage than the staff who did not possess lifeguard certificate at 39.9%. In the case of lifeguard certificate, staff who possess lifeguard certificate had better knowledge about the usage instructions for Automated External Defibrillator, than the staff who did not possess the certificate, and meaningful difference was seen in accordance with the possession of the lifeguard certificate(t=4.31, p

Patients undergoing pulmonary resection are thought to be at high risk for the development of postoperative pulmonary complications (PPCs), and these complications may lead to serious morbidity. The purpose of this study was to identify the factors associated with postoperative pulmonary complications in patients undergoing lung cancer resection and to determine the effect of PPCs on survival.The study involved a retrospective review of 635 patients who had undergone curative resection for lung cancer. The patient group included 504 males (79.4%), and the overall mean age was 61.3 years. Patients were classified as those who had experienced PPCs (PPCs group, n = 105, 16.5%) or those who had not (no-PPCs group, n = 530, 83.5%).The surgical procedures performed were 101 pneumonectomies (15.9%), 505 lobectomies (79.5%), and 29 lesser resections (4.6%). Cancer types comprised 330 squamous cell carcinomas (52.0%), 255 adenocarcinomas (40.2%) and 50 others (7.8%). Univariate analysis showed that the following factors were predictors for PPCs: male sex, erythrocyte sedimentation rate, preoperative serum fibrinogen level, pulmonary function, chronic obstructive pulmonary disease, smoking, double primary cancer, and surgical duration. Multivariate logistic regression showed that preoperative serum fibrinogen level (p0.001), surgical duration (p0.0001) and being male (p = 0.02) were significant predictors of PPCs. Overall survival 3 years after surgery was 68.2% in no-PPCs group and 38.8% in PPCs group (p0.0001). Regardless of tumor staging, overall survival differed significantly between PPCs and no-PPCs groups, whereas disease-free survival did not.Higher preoperative serum fibrinogen levels, longer surgical duration, and being male were the predictive factors for PPCs in surgical candidates. The development of PPCs was linked to a shortened overall survival.

[Purpose] The aim of this study was to determine the effects of a 12-week walking program on increasing an individual’s self-management and decreasing the risk factors of metabolic syndrome in the older adult population. [Subjects] A total of 31 older adults participated in this study. Eighteen participants in the experimental group and 13 controls completed the pretest and posttest measures. A walking exercise and health education were provided for the experimental group. Data were analyzed by ANCOVAs to examine group differences. [Results] At the end of the 12-week study period, the experimental group showed a significant improvement in individuals’ ability to self-manage their health compared to the control group. Also, there were significant differences between the two groups in the total numbers of risk factors of metabolic syndrome, systolic blood pressure and BMI. No significant difference in blood sugar levels, HDL-C, waist circumference, and triglyceride levels were found between the experimental and control group. [Conclusion] This study revealed that a combination of health education and for walking exercise can lead to improved lifestyle management and reduce risk factors of metabolic syndrome for the elderly population of Korea.

The Beijing family of Mycobacterium tuberculosis has been emerging in the world. However, there are few nationwide data of genotypic distribution in Korea. This study aimed to identify the genotypic diversity of clinical isolates of M. tuberculosis and to demonstrate the population of Beijing family in Korea. We collected 96 clinical M. tuberculosis isolates from 11 university hospitals nationwide in Korea from 2008 to 2009. We observed 24 clusters in IS6110-RFLP analysis and 19 patterns in spoligotyping. Seventy-five isolates were confirmed to be Beijing family. Two isolates of the K strain and 12 isolates of the K family strain were also found. We found that drug resistance phenotypes were more strongly associated with Beijing family than non-Beijing family (P=0.003). This study gives an overview of the distribution of genotypes of M. tuberculosis in Korea. These findings indicate that we have to pay more attention to control of M. tuberculosis strains associated with the Beijing family.

A multiplex polymerase chain reaction (PCR) assay that is capable of detecting and typing six serotypes of respiratory adenovirus (Ad) was developed, using multiple sets of type-specific primers. The detection of each different serotype depended on distinguishing different numbers and sizes of amplification products on agarose gels following PCR. The multiplex PCR was tested with 26 clinical Ad isolates and other respiratory viruses including influenza viruses, parainfluenza viruses, and respiratory syncytial viruses as well as respiratory bacterial pathogens such as Chlamydia pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. The multiplex PCR for the detection and typing of Ads gave an excellent correlation with the results by conventional typing with type-specific antisera. This assay may serve as a rapid means of confirming Ad with simultaneous serotype identification of the isolates. It will also have relevance as an adjunctive tool to conventional serotyping for diagnostic and epidemiological purposes.